Sunday, January 06, 2008

The Scream of Silence

This young guy comes to the emergency room.
Problem: a small mass on his butt.

The emergency room doctor feels like there's a big infection and decides to keep him in the hospital. The young patient gets a surgery for his back, and a huge 30-cm cancer is found stuck to his muscles and bones.
Further tests show that this is an aggressive cancer that has spread to his liver and lungs as well.

Tom has been in the hospital for 3 months now, and had a major surgery to remove the tumor in hope of prolonging his life a few more months. He now has a very large scar on his buttocks and thighs. He hasn't walked or even sat in his bed in three months.

He is 36, but now looks double his age.

I have seen many depressed people. I've met some people who tried to kill themselves because of depression. I had a patient who once tried to slash his wrists inside the hospital. But I've never met a person with this kind of depression that this guy has.

Tom stopped talking. He barely says anything now. His brain, vocal cords, mouth and tongue are (still) working, but he's not talking. I asked him how was his day going, did he have any pain, did he feel like crap, and he kept silent.

I've never seen anyone so depressed, so defeated, and so broken like him.

Eventually, we told him there was no chance for him to be cured, and we'd prefer him to receive comfort care at home where he can be pain-free and more comfortable. He said a few words, "I don't want to". He wanted to stay in the hospital and live the illusion that one day he might get better, but the end is very close and we all know it. I know that he'll die in pain, and that he'll die silent, very very silent.

Silence was his language. It was his voice and his way of communication. It could have been the source of his strength or the expression of his defeat, or maybe both. I would never know, and I would never ask him because he'd answer me with a long pause that will make me ashamed of myself.
I've just learned that silence can be the most powerful scream.


Anonymous said...

Powerful indeed.


Rambling Hal said...

Hareega, what about you? How do you deal with depression? Because you see things everyday that would probably make other people (like me) go home and bang their head against the wall and cry until they pass out. But you doctors, you seem to have the strength to get past that, to do your healing jobs and not let the pain you see every day depress you.

I ask this because my mother is the same way and I don't get it. She doesn't provide a satisfactory answer. This cancer patient's story made me cry. How can you not cry enough to do you job?

It's a mystery to me. I think doctors are made from a different material altogether than the rest of us stupid humans.

May God give you all strength.

(Yes I'm being serious today, it's my new thing, how am I doing?)

The Observer said...

That is sad!

Why don't you give him anti depressent pills? would that help? At least making him a bit happy in his last days?!

Anonymous said...

hmmm.. I'm thinknig of the Elizabeth Kubler-Ross'stages of grief.He's just a step away from acceptance. You think he'll come to it. It's horrible when you cant offer anymore help. wa ni3ma billah, all in his hands.

Hareega said...

anonymous, thanks for checking

rambling hal, it's also a mystery to me. I kinda understand it when people say that doctors get used to it because somehow we do, but nothing in the world can prepare you for the death of a human being. I worked in a cancer center for a few months and although I love the science of cancer, I truly hated those months because of the death of a lot of young people. I'm sorry but I don't have an answer to your question. I don't know if anyone does.

Hareega said...

Observer, anti-depressants are never the solution. The best way to treat depression is to treat the reason causing it. Anti-depressants are used to treat extreme case of depression or if one is depressed all the time for no obvious reason. This guy is depressed because he's dying and anti-depressants will probably not help, but he's on them anyway. Their effect doesn't usually start before 2-4 weeks. One major side-effect of them: it can lead depressed people to kill themselves! The reason for this is that sometimes antidepressants help very depressed people to regain some of their "mental energy" and that will allow them to start thinking of suicide and have a plan on how are they going to kill themselves. It does happen that depressed might commit suicide right after they're started on treatment!

Hareega said...

batoul... yep, for some people these stages are reversed; other just skip a stage or two, and some others never go through all the stages, maybe they just don't live long enough or they're just kept in denial all the time.

The Observer said...

hareega, thanks for the info, i didnt know that before. This is so sad. Allah ye3eeno :(

Anonymous said...

I have to write something but actually i don't know what to say :( I guess when someone has that much of grief, nothing can make him speak.. Silence is powerful indeed!

tinkerbella said...

this was a very sad post.. poor guy :'(

raindrop said...

most powerful & painful at the same time.

thanks for sharing Hareega

Hareega said...

thanks guys for reading